Provider Demographics
NPI:1518614726
Name:EDWARDS, AMY M
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2752
Mailing Address - Country:US
Mailing Address - Phone:276-236-6341
Mailing Address - Fax:
Practice Address - Street 1:140 LARKSPUR LN
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2752
Practice Address - Country:US
Practice Address - Phone:276-236-6341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)